Healthcare Provider Details

I. General information

NPI: 1215574413
Provider Name (Legal Business Name): HEALING PINES RECOVERY, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2019
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5550 COUNTY ROAD 124
ELIZABETH CO
80107
US

IV. Provider business mailing address

PO BOX 1950
ELIZABETH CO
80107-1950
US

V. Phone/Fax

Practice location:
  • Phone: 949-304-0040
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JOHN TUCKER
Title or Position: COO
Credential:
Phone: 208-680-5663